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ORIGINAL ARTICLE
Year : 2017  |  Volume : 52  |  Issue : 4  |  Page : 296-305

Genu varum with medial compartment osteoarthritis treated with puddu plate


Department of Orthopedic Surgery, El-Sahil Teaching Hospital, Cairo, Egypt

Correspondence Address:
Ahmed M Elsersawy
Department of Orthopedic Surgery, El-Sahil Teaching Hospital, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/eoj.eoj_76_17

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Background Gonarthrosis in the relatively young and active population causes major daily discomfort and disability. If the arthritic process is mainly limited to the medial compartment, the axis of a varus knee can be realigned laterally with high tibial osteotomy (HTO) to unload the medial compartment and allow some cartilage regeneration and pain relief. Many techniques have been developed (i.e. closing wedge, opening wedge, dome, and ‘en chevron’ osteotomies), but opening (medial) and closing (lateral) wedge osteotomies are the most commonly used. With opening wedge HTO, good long-term results are obtained with a correct patient selection (a young patient<60 years of age, isolated medial osteoarthritis, and with good range of motion and without ligamentous instability) and a precise surgical technique. This study describes the outcomes of patients who underwent opening wedge HTO using Puddu plate. Aim The aim of this study was to confirm that medial opening wedge HTO with Puddu plate fixation can be a reliable procedure for the treatment of medial compartment osteoarthritis of the knee associated with varus deformity. Patient and methods With meticulous patient selection, an open-wedge HTO using the Puddu plate was performed in 15 knees of 15 patients at El-Sahil Teaching Hospital between May 2010 and March 2013 for a young patient population (<60 years of age) with isolated medial osteoarthritis, with good range of motion, and without ligamentous instability. There were four women and 11 men. Overall, nine patients were affected in the left knee and six in the right. Their mean age was 25.4 years. The average varus angle to be corrected was 8.13. Results All of the patients were followed up for an average of 12 months (8–16 months). There was no nonunion or delayed union in this group, and all patients were encouraged to start full weight-bearing after 6 or 8 weeks. The overall fineness rate was 80% (12/15) at the end of the follow-up with improved symptoms. Two cases of wound infection were treated with antibiotic and daily dressing. One case of deep vein thrombosis was treated satisfactorily with medical therapy. Two had patients had undercorrection, two patients need cancellous bone graft, and three patients needed postoperative casting. Conclusion With meticulous patient selection, medial opening HTO using the Puddu plate has a very high success rate. The benefits of this technique is the short time of operation in comparison with other techniques, no graft used, and no casting postoperatively because the Puddu plate gives rigid fixation, which leads to early range of motion in the knee.


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